DISCUSSION:

A settlement agreement has been reached in the Julia M. vs. Scott lawsuit referred to in Income Maintenance Memorandum IM-67 dated July 24, 2007. This lawsuit was brought on behalf of all children residing in Missouri and who are receiving or who will receive MO HealthNet coverage and are required to pay a premium under RSMo 208.640. The lawsuit alleged that MO HealthNet for Kids Premium participants were not being notified of or given the following rights prior to disenrolling the participant for failure to pay the premium:

1. a right to appeal and notification to provide continued assistance pending a hearing; and
2. a right to an ex parte review to determine participant's potential eligibility under another MO HealthNet program.

The settlement agreement implemented the following actions:

• MO HealthNet Division changed the invoicing process to notify the participant of the right to report income changes and the right to a hearing while continuing coverage. Refer to Income Maintenance Memorandum IM-21 dated March 5, 2008, for further information regarding this action.
• Family Support Division sent a notice offering an ex parte review to each MO HealthNet for Kids premium participant who between September 1, 2005, and January 16, 2008, had a MO HealthNet for Kids case close due to non-payment of premium, and who did not become covered under another MO HealthNet program within 90 days. Refer to Income Maintenance Memorandum IM-16 dated February 1, 2008, for further information regarding this action.
• The Court has ordered that a Notice of Proposed Settlement be made available to MO HealthNet for Kids participants. The notice explains the basic terms of the settlement. The notice, in both English and Spanish, is being made available in the following manner:
  • On the Department of Social Services website, located at https://dss.mo.gov/pr_health.htm; and
  • Posted in each Family Support Division County Office lobby. Each office will print and post the attached English and Spanish versions of the Notice of Proposed Settlement as soon as this memorandum is received. The notices must remain posted through April 18, 2008.
• MO HealthNet Division (MHD) will be reporting to the plaintiffs information regarding the number of notifications and terminations of coverage due to non-payment of premiums on a regular basis. MHD will also report on the number of requests for hearing. If an FSD eligibility specialist receives a request for a hearing from a participant who was terminated due to failure to pay premium, follow the instructions in Income Maintenance Memorandum IM-21 dated March 5, 2008.

NOTE: Revisions to the invoicing notification system now allow for the termination of MO HealthNet for Kids healthcare coverage due to non-payment of premium. Refer to Income Maintenance Memorandums IM-67 dated July 24, 2007 (for information regarding the Julia M. vs. Scott Order for injunctive relief) and IM-21 dated March 5, 2008 (for information regarding invoicing revisions).

NECESSARY ACTION:

• Post the attached Notice of Settlement (English and Spanish versions) in each FSD county office lobby immediately upon receipt of this memorandum.
• Review this memorandum with appropriate staff.

LH

ATTACHMENTS:

• Notice of Settlement (English version)
• Notice of Settlement (Spanish version)